Topline  Presentation Points

  • Early (very) Favourable  
    • “In PET-2–negative patients, radiotherapy cannot be omitted from CMT without clinically relevant loss of tumor control.” 
    • “In early-stage favorable HL, a positive PET after two cycles ABVD indicates a high risk for treatment failure, particularly when a Deauville score of 4 is used as a cutoff for positivity.” 
      • PET scan after 2 cycles remains relevant even if RT is planned for PET-negative patients. 
  • Early Unfavourable HL 
    • GHSG HD17 Early Unfavourable
    • (Lancet Oncol 2021; 22: 223–34)
      • RT Late-effects likely outweigh benefit 
      • Cardiotoxic Equivalence: 
        • Analysis of Nine EORTC/LYSA HL Trials  
        • 2 cycles of ABVD = 10Gy mean heart dose
  • RT for Advanced Stage HL 
    • If using ABVD backbone: 
      • RT to EOC PET-avid where there has been adequate reduction in mass on CT and decrease in SUV. 
      • Consider RT to sites of bulk >10cm (PET –’ve) may improve PFS by ~ 7-10% if ABVD alone is used. 
      • If using BEACOPPesc backbone: RT to PET-avid sites >2.5cm 
      • Typically, DS 4 with reduced SUV and adequate reduction in mass.